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Abstract

When Marilyn Liota began her career with the Visiting Nurse Service of New York (VNSNY), she worked the teeming streets of Manhattan's Lower East Side, toting rudimentary equipment up tenement stairs to bring care to her patients.

"We carried a blood pressure cuff, masks, and an apron," Liota recalled. "And," she added with a laugh, "we wore a lovely hat designed by the legendary 1940s milliner Lilly Dache."

That was more than half a century ago. Today visiting nurses serve an ethnically varied population and treat complex conditions; they also provide palliative care. But two things haven't changed: Liota, who turned 80 years old last December, is still with the VNSNY, the nation's largest nonprofit home health care agency. And "the people part remains the same," she said. "They still want that personal touch."

Liota was inspired to become a nurse after reading The House on Henry Street, the story of Lillian D. Wald, a social activist who in 1893 founded the precursor to the VNSNY, the Henry Street Settlement, which offered social services and health care to poor immigrants on the Lower East Side.

"I could never decide between teacher, social worker, or nurse," said Liota. "Community health nursing encompasses all three."

When she told her nursing instructors of her career choice, "they reprimanded me. They said 'no one knows what they want to do before they graduate.' They saw the role of nurses as primarily to staff hospitals."

A native New Yorker raised in Brooklyn, Liota attended Hunter College and Columbia University's Teachers College, where she received a master's degree in 1951.

After graduation, she fulfilled a six-month commitment to remain with the school by working in the new communicable diseases' unit at Columbia Presbyterian Hospital (now New York-Presbyterian Hospital- Columbia University Medical Center). In 1952 she joined the VNSNY and was assigned to the same Lower East Side neighborhood where Wald had founded public health nursing.

It was the height of the nation's last major polio epidemic and Liota saw many patients with the disease. "People were on ventilators," she recalled, "mostly robust young people. We began rehabilitative nursing, an extraordinary kind of care." Nurses wrapped the patients' limbs in warm flannel to relax the muscles before performing physical therapy. It was considered a big advancement because it lessened the pain. A teenage girl with polio whom Liota treated in those days is still a patient. She's 69 years old now.

Liota also worked in New York's sprawling Queens neighborhoods and in the poor areas of Harlem and the South Bronx. The VNSNY continued to advance technologically, as nurses stopped keeping handwritten records and instead used electronic tablets. And today nurses get laboratory results in real time, which allows them to make critical adjustments to patients' medication in consultation with their physicians. "It's amazing," Liota said. "We went from an organization that provided care only for acute conditions to one with hospice, rehabilitation, HIV-prevention, mental health, and maternal- newborn programs."

The VNSNY hires many nurses whose cultural backgrounds and language skills reflect the ethnic groups in their areas of service. "We have nurses who speak Spanish, Korean, Russian, Cantonese, and Mandarin Chinese, among other languages," Liota said. The service also employs translators to accompany nurses on their home visits and patients to physicians' appointments.

Today Liota oversees 180 nurses as a regional administrator. "We have 11,000 staff members delivering care to 31,000 patients a day," she said. "When I first became a manager, my biggest concern was leaving the patients, but I find that the nurses I supervise can benefit from my experience."

This year the VNSNY celebrates its 115th anniversary, and having reached her own milestone recently, Liota can't help but take stock in the agency and its mission. "Every year there's a new challenge we have to face," she said. "But the patients' needs remain the same: they want personalized care, they want to feel important to someone."